Provider Demographics
NPI:1336322783
Name:DAVID L. MANZO, M.D., P.C.
Entity Type:Organization
Organization Name:DAVID L. MANZO, M.D., P.C.
Other - Org Name:MANZO EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:MANZO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-541-4200
Mailing Address - Street 1:621 W 11 MILE RD
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-2201
Mailing Address - Country:US
Mailing Address - Phone:248-541-4200
Mailing Address - Fax:248-541-4969
Practice Address - Street 1:621 W 11 MILE RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-2201
Practice Address - Country:US
Practice Address - Phone:248-541-4200
Practice Address - Fax:248-541-4969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4113369OtherAETNA
MI4229975 TYPE 10Medicaid
MI0N12090Medicare PIN
MI4113369OtherAETNA
MI5453840001Medicare NSC